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Bazie MM, Sanou M, Djigma FW, Compaore TR, Obiri-Yeboah D, Kabamba B, Nagalo BM, Simpore J, Ouédraogo R. Genetic diversity and occult hepatitis B infection in Africa: A comprehensive review. World J Hepatol 2024; 16:843-859. [PMID: 38818293 PMCID: PMC11135261 DOI: 10.4254/wjh.v16.i5.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Occult hepatitis B infection (OBI) is a globally prevalent infection, with its frequency being influenced by the prevalence of hepatitis B virus (HBV) infection in a particular geographic region, including Africa. OBI can be transmitted through blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma (HCC). The associated HBV genotype influences the infection. AIM To highlight the genetic diversity and prevalence of OBI in Africa. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed, Google Scholar, Science Direct, and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa. RESULTS The synthesis included 83 articles, revealing that the prevalence of OBI varied between countries and population groups, with the highest prevalence being 90.9% in patients with hepatitis C virus infection and 38% in blood donors, indicating an increased risk of HBV transmission through blood transfusions. Cases of OBI reactivation have been reported following chemotherapy. Genotype D is the predominant, followed by genotypes A and E. CONCLUSION This review highlights the prevalence of OBI in Africa, which varies across countries and population groups. The study also demonstrates that genotype D is the most prevalent.
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Affiliation(s)
- Michee M Bazie
- Department of Medicine, Transmissible Diseases Laboratory, Université Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
| | - Mahamoudou Sanou
- Department of Medicine, Transmissible Diseases Laboratory, Université Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
| | - Florencia Wendkuuni Djigma
- Department of Biochemistry and Microbiology, Molecular Biology and Genetics Laboratory, University Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso.
| | - Tegwinde Rebeca Compaore
- Infectious and parasitic disease Laboratory, Health Sciences Research Institute, IRSS/CNRST, National Center for Scientific and Technological Research, Ouagadougou 0000, Burkina Faso
| | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, PMB, Cape Coast 0000, Ghana
| | - Benoît Kabamba
- Department of Clinical Biology, Virology Laboratory, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Bruxelles 0000, Belgium
| | | | - Jacques Simpore
- Department of Biochemistry and Microbiology, Molecular Biology and Genetics Laboratory, University Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
| | - Rasmata Ouédraogo
- Department of Medicine, Transmissible Diseases Laboratory, Université Joseph KI-ZERBO, Ouagadougou 0000, Burkina Faso
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Dzudzor B, Nsowah KK, Agyemang S, Vento S, Amarh V, Boima V, Tachi K. Overt and occult hepatitis B virus infection detected among chronic kidney disease patients on haemodialysis at a Tertiary Hospital in Ghana. PLoS One 2024; 19:e0290917. [PMID: 38437229 PMCID: PMC10911607 DOI: 10.1371/journal.pone.0290917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
Hepatitis B virus (HBV) infection is endemic in Ghana and chronic kidney disease patients on haemodialysis are a high-risk group for HBV infection. We determined the prevalence of overt and occult HBV infection among haemodialysis patients at the Korle Bu Teaching Hospital in Ghana. 104 consenting End Stage Renal Disease patients on long-term haemodialysis were recruited for the study and their socio-demographic, clinical and laboratory information were obtained using structured questionnaire. All the participants were tested for the hepatitis B surface antigen (HBsAg). The HBsAg-negative participants were re-tested for hepatitis B surface antibody (HBsAb), hepatitis B core antibody (HBcAb) and HBV DNA using chemiluminescence and Roche COBAS Ampli-Prep/TaqMan analyser and real-time polymerase chain reaction. Eight (7.7%) of the total participants were positive for HBsAg. Among the 96 HBsAg-negative participants, 12.5% (12) were HBcAb-positive, 7.3% (7) had detectable HBV DNA (mean = 98.7±53.5 IU/mL) and 40.6% (39) were positive for HBsAb. Five out of the 7 HBV DNA-positive participants were males and only one participant was negative for HBcAb. Seventy-three out of the 96 HBsAg-negative participants were vaccinated and 37 of these vaccinated individuals had significant HBsAb titres (mean = 423.21± 380.72 IU/mL). Our data demonstrated that the prevalence of overt and occult HBV infection among the haemodialysis (HD) patients was 7.7% and 7.3%, respectively, and only 50.7% of those who showed proof of vaccination were protected from HBV infection.
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Affiliation(s)
- Bartholomew Dzudzor
- Department of Medical Biochemistry, University of Ghana Medical School, Korle-Bu, Ghana
| | - Kingsley Kwame Nsowah
- Department of Medical Biochemistry, University of Ghana Medical School, Korle-Bu, Ghana
| | | | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
| | - Vincent Amarh
- Department of Medical Biochemistry, University of Ghana Medical School, Korle-Bu, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle-Bu, Ghana
| | - Kenneth Tachi
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle-Bu, Ghana
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Athalye S, Patil A, Khargekar N, Shinde S, Chavan S, Dixit A, Shankarkumar A, Madkaikar M, Banerjee A. Efficacy of combined HBsAg, anti-HBc and anti-HBs screening in minimizing transfusion transmission risk of hepatitis B infection in low resource setting. Heliyon 2024; 10:e25805. [PMID: 38356514 PMCID: PMC10865305 DOI: 10.1016/j.heliyon.2024.e25805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Background Hepatitis B Virus (HBV), and occult Hepatitis B in particular, is a major concern in the transfusion scenario, especially in endemic countries. This study attempted to estimate the prevalence of occult Hepatitis B infection (OBI) among voluntary blood donors in Maharashtra and to evaluate the role of combined screening strategy with implications in minimizing the current transfusion risks of seropositive OBI. Methods Donor samples were collected from 80 eligible blood banks from various districts of Maharashtra between 2014 and 2017. ELISA based screening of HBsAg, anti-HBc (total and IgM), anti-HBs titres. Real-time quantitative PCR for Hepatitis B Virus DNA (HBV DNA) were performed for all HBsAg and or anti-HBc positive samples. Results Out of 2398 samples tested, 20 (0.83%) samples were positive for HBsAg, whereas 547 (22.81%) were positive for anti-HBc. Out of 547 samples, 16 (2.92%) were positive for HBV DNA with median level at 247.89 IU/mL (IQR: 126.05-666.67 IU/mL). Anti-HBs levels were positive in 35.83% of OBI cases. ROC curve analysis showed that combined HBsAg, anti-HBc and anti-HBs (>50 mIU/mL) screening can more efficiently detect HBV infection in blood donors than HBsAg alone. Conclusions A combined HBsAg, anti-HBc and anti-HBs screening for donor samples could be an alternative achievable strategy to minimize the HBV transmission as well as financial burden. In resource limited setup, the proposed combined strategy could be helpful in minimizing the risk of OBI transmission.
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Affiliation(s)
- Shreyasi Athalye
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Amruta Patil
- Department of Medical Biotechnology, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Naveen Khargekar
- Hematogenetics Department, ICMR-National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Shailesh Shinde
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Shreya Chavan
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Abhay Dixit
- Project ACCELERATE, YRGCARE, Mumbai, Maharashtra, India
| | - Aruna Shankarkumar
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Manisha Madkaikar
- Paediatric Immunology and Leukocyte Biology, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
| | - Anindita Banerjee
- Transfusion Transmission Disease Department, ICMR- National Institute of Immunohaematology, Mumbai, Maharashtra, 400 012, India
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Alkhazashvili M, Bloch EM, Shadaker S, Kuchuloria T, Getia V, Turdziladze A, Armstrong PA, Gamkrelidze A. Advancing blood transfusion safety using molecular detection in the country of Georgia. Transfus Clin Biol 2023; 30:307-313. [PMID: 36907246 PMCID: PMC10958484 DOI: 10.1016/j.tracli.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND In 2015, the country of Georgia initiated its hepatitis C virus (HCV) elimination program. Given a high background incidence of HCV infection, centralized nucleic acid testing (NAT) of blood donations was prioritized for implementation. STUDY DESIGN AND METHODS Multiplex NAT screening for HIV, HCV and hepatitis B virus (HBV) was launched in January 2020. An analysis was conducted of serological and NAT donor/donation data for the first year of screening (through December 2020). RESULTS A total of 54,116 donations representing 39,164 unique donors were evaluated. Overall, 671 donors (1.7%) tested positive for at least one infectious marker by serology or NAT, with the highest prevalence among donors aged 40-49 years (2.5%; n = 200), male (1.9%; n = 524), replacement (2.8%; n = 153) and first time (2.1%; n = 642) donors. Sixty donations were seronegative but NAT positive, and therefore would not have been found by traditional serology testing alone. These were more likely among female vs. male (adjusted odds ratio [aOR] 2.06; 95% confidence interval [95%CI]: 1.05-4.05), paid (aOR 10.15; 95%CI: 2.80-36.86) or voluntary (aOR 4.30; 95%CI: 1.27-14.56) vs replacement, and repeat vs. first time (aOR 13.98; 95%CI: 4.06-48.12) donors. On repeat serological testing (including HBV core antibody [HBcAb] testing), 6 HBV + donations, 5 HCV + donations and 1 HIV + donations were deemed NAT yield (detected through the implementation of NAT, and would have otherwise been missed by serology screening alone). CONCLUSION This analysis offers a regional model for NAT implementation, demonstrating the feasibility and clinical utility in a nationwide blood program.
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Affiliation(s)
- Maia Alkhazashvili
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; The University of Georgia, School of Health Sciences, Tbilisi, Georgia.
| | - Evan M Bloch
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Shaun Shadaker
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, United States
| | | | - Vladimer Getia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Paige A Armstrong
- Johns Hopkins University School of Medicine, Baltimore, United States
| | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia; The University of Georgia, School of Health Sciences, Tbilisi, Georgia
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Anne PB, Gupta A, Misra S, Sharma SK, Garg MK, Bajpayee A, Bundas S, Bohra M, Asirvatham V. Economic Evaluation of Nucleic Acid Testing for Screening of Blood Donations for Thalassemia Patients (ECONAT) in Western India. Indian J Hematol Blood Transfus 2023; 39:317-324. [PMID: 37006984 PMCID: PMC10064373 DOI: 10.1007/s12288-022-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Transfusion Transmitted infections(TTI) are of significant concern for blood safety. The thalassemia patients who receive multiple transfusions are at an increased risk of TTIs and the Nucleic Acid Test (NAT ) has been advocated for safe blood. Though NAT can reduce the window period compared to serology, cost is a constraint. Methods The thalassemia patient and NAT yield data from the centralized NAT lab in AIIMS Jodhpur was evaluated for cost-effectiveness using the Markov model. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the difference between the cost for NAT and the cost of medical management of TTI-related complications by the product of the difference in utility value of a TTI health state with time and Gross National Income(GNI) per capita. Results Out of the 48,762 samples tested by NAT, 43 samples were discriminated NAT yield all of which were reactive for Hepatitis B (NAT yield of 1:1134). There was no HCV and HIV NAT yield despite HCV being the most prevalent TTI in this population. The cost of this intervention was INR 5,85,14,400. The number of lifetime QALY saved was 1.38 years. The cost of medical management is INR 82,19,114. Therefore the ICER for intervention is INR 3,64,45,860 per QALY saved which is 274 times the GNI per capita of India. Conclusions The provision of IDNAT-tested blood for thalassemia patients in Rajasthan state was not found to be cost-effective. Measures to bring down the cost or alternative options to increase blood safety should be explored.
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Affiliation(s)
- Puneeth Babu Anne
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Anubhav Gupta
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, 342005 Jodhpur, India
| | | | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Archana Bajpayee
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - Sunita Bundas
- Department of Immunohematology and Transfusion Medicine, S.M.S. Medical college, 302004 Jaipur, India
| | - Manju Bohra
- Department of Immunohematology and Transfusion Medicine, Dr. S. N. Medical College, 342003 Jodhpur, India
| | - Vasanth Asirvatham
- Department of Transfusion Medicine and Blood Bank, All India Institute of Medical Sciences, 342005 Jodhpur, India
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Beverly A, Ong G, Kimber C, Sandercock J, Dorée C, Welton NJ, Wicks P, Estcourt LJ. Drugs to reduce bleeding and transfusion in major open vascular or endovascular surgery: a systematic review and network meta-analysis. Cochrane Database Syst Rev 2023; 2:CD013649. [PMID: 36800489 PMCID: PMC9936832 DOI: 10.1002/14651858.cd013649.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Vascular surgery may be followed by internal bleeding due to inadequate surgical haemostasis, abnormal clotting, or surgical complications. Bleeding ranges from minor, with no transfusion requirement, to massive, requiring multiple blood product transfusions. There are a number of drugs, given systemically or applied locally, which may reduce the need for blood transfusion. OBJECTIVES To assess the effectiveness and safety of anti-fibrinolytic and haemostatic drugs and agents in reducing bleeding and the need for blood transfusion in people undergoing major vascular surgery or vascular procedures with a risk of moderate or severe (> 500 mL) blood loss. SEARCH METHODS We searched: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL, and Transfusion Evidence Library. We also searched the WHO ICTRP and ClinicalTrials.gov trial registries for ongoing and unpublished trials. Searches used a combination of MeSH and free text terms from database inception to 31 March 2022, without restriction on language or publication status. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adults of drug treatments to reduce bleeding due to major vascular surgery or vascular procedures with a risk of moderate or severe blood loss, which used placebo, usual care or another drug regimen as control. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were units of red cells transfused and all-cause mortality. Our secondary outcomes included risk of receiving an allogeneic blood product, risk of reoperation or repeat procedure due to bleeding, risk of a thromboembolic event, risk of a serious adverse event and length of hospital stay. We used GRADE to assess certainty of evidence. MAIN RESULTS We included 22 RCTs with 3393 participants analysed, of which one RCT with 69 participants was reported only in abstract form, with no usable data. Seven RCTs evaluated systemic drug treatments (three aprotinin, two desmopressin, two tranexamic acid) and 15 RCTs evaluated topical drug treatments (drug-containing bioabsorbable dressings or glues), including fibrin, thrombin, collagen, gelatin, synthetic sealants and one investigational new agent. Most trials were conducted in high-income countries and the majority of the trials only included participants undergoing elective surgery. We also identified two ongoing RCTs. We were unable to perform the planned network meta-analysis due to the sparse reporting of outcomes relevant to this review. Systemic drug treatments We identified seven trials of three systemic drugs: aprotinin, desmopressin and tranexamic acid, all with placebo controls. The trials of aprotinin and desmopressin were small with very low-certainty evidence for all of our outcomes. Tranexamic acid versus placebo was the systemic drug comparison with the largest number of participants (2 trials; 1460 participants), both at low risk of bias. The largest of these included a total of 9535 individuals undergoing a number of different higher risk surgeries and reported limited information on the vascular subgroup (1399 participants). Neither trial reported the number of units of red cells transfused per participant up to 30 days. Three outcomes were associated with very low-certainty evidence due to the very wide confidence intervals (CIs) resulting from small study sizes and low number of events. These were: all-cause mortality up to 30 days; number of participants requiring an allogeneic blood transfusion up to 30 days; and risk of requiring a repeat procedure or operation due to bleeding. Tranexamic acid may have no effect on the risk of thromboembolic events up to 30 days (risk ratio (RR) 1.10, 95% CI 0.88 to 1.36; 1 trial, 1360 participants; low-certainty evidence due to imprecision). There is one large ongoing trial (8320 participants) comparing tranexamic acid versus placebo in people undergoing non-cardiac surgery who are at high risk of requiring a red cell transfusion. This aims to complete recruitment in April 2023. This trial has primary outcomes of proportion of participants transfused with red blood cells and incidence of venous thromboembolism (DVT or PE). Topical drug treatments Most trials of topical drug treatments were at high risk of bias due to their open-label design (compared with usual care, or liquids were compared with sponges). All of the trials were small, most were very small, and few reported clinically relevant outcomes in the postoperative period. Fibrin sealant versus usual care was the topical drug comparison with the largest number of participants (5 trials, 784 participants). The five trials that compared fibrin sealant with usual care were all at high risk of bias, due to the open-label trial design with no measures put in place to minimise reporting bias. All of the trials were funded by pharmaceutical companies. None of the five trials reported the number of red cells transfused per participant up to 30 days or the number of participants requiring an allogeneic blood transfusion up to 30 days. The other three outcomes were associated with very low-certainty evidence with wide confidence intervals due to small sample sizes and the low number of events, these were: all-cause mortality up to 30 days; risk of requiring a repeat procedure due to bleeding; and risk of thromboembolic disease up to 30 days. We identified one large trial (500 participants) comparing fibrin sealant versus usual care in participants undergoing abdominal aortic aneurysm repair, which has not yet started recruitment. This trial lists death due to arterial disease and reintervention rates as primary outcomes. AUTHORS' CONCLUSIONS Because of a lack of data, we are uncertain whether any systemic or topical treatments used to reduce bleeding due to major vascular surgery have an effect on: all-cause mortality up to 30 days; risk of requiring a repeat procedure or operation due to bleeding; number of red cells transfused per participant up to 30 days or the number of participants requiring an allogeneic blood transfusion up to 30 days. There may be no effect of tranexamic acid on the risk of thromboembolic events up to 30 days, this is important as there has been concern that this risk may be increased. Trials with sample size targets of thousands of participants and clinically relevant outcomes are needed, and we look forward to seeing the results of the ongoing trials in the future.
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Affiliation(s)
- Anair Beverly
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Giok Ong
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Catherine Kimber
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Josie Sandercock
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Carolyn Dorée
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Wicks
- Cardiac Anaesthesia and Intensive Care, University Hospital Southampton, Southampton, UK
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
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Zhong Y, Xu P, Zhong S, Ding J. A sequential decoding procedure for pooled quantitative measure. Seq Anal 2022. [DOI: 10.1080/07474946.2022.2043049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yunning Zhong
- School of Mathematics and Statistics, Fujian Normal University, Fuzhou, Fujian, China
| | - Ping Xu
- School of Mathematics and Statistics, Guangxi Normal University, Guilin, Guangxi, China
| | - Siming Zhong
- School of Mathematics and Statistics, Guangxi Normal University, Guilin, Guangxi, China
| | - Juan Ding
- School of Mathematics and Statistics, Guangxi Normal University, Guilin, Guangxi, China
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Arnold J, Chapman J, Arnold M, Dinu CZ. Hyaluronic Acid Allows Enzyme Immobilization for Applications in Biomedicine. BIOSENSORS 2022; 12:bios12010028. [PMID: 35049657 PMCID: PMC8773612 DOI: 10.3390/bios12010028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 12/28/2022]
Abstract
Enzymes are proteins that control the efficiency and effectiveness of biological reactions and systems, as well as of engineered biomimetic processes. This review highlights current applications of a diverse range of enzymes for biofuel production, plastics, and chemical waste management, as well as for detergent, textile, and food production and preservation industries respectively. Challenges regarding the transposition of enzymes from their natural purpose and environment into synthetic practice are discussed. For example, temperature and pH-induced enzyme fragilities, short shelf life, low-cost efficiency, poor user-controllability, and subsequently insufficient catalytic activity were shown to decrease pertinence and profitability in large-scale production considerations. Enzyme immobilization was shown to improve and expand upon enzyme usage within a profit and impact-oriented commercial world and through enzyme-material and interfaces integration. With particular focus on the growing biomedical market, examples of enzyme immobilization within or onto hyaluronic acid (HA)-based complexes are discussed as a definable way to improve upon and/or make possible the next generation of medical undertakings. As a polysaccharide formed in every living organism, HA has proven beneficial in biomedicine for its high biocompatibility and controllable biodegradability, viscoelasticity, and hydrophilicity. Complexes developed with this molecule have been utilized to selectively deliver drugs to a desired location and at a desired rate, improve the efficiency of tissue regeneration, and serve as a viable platform for biologically accepted sensors. In similar realms of enzyme immobilization, HA’s ease in crosslinking allows the molecule to user-controllably enhance the design of a given platform in terms of both chemical and physical characteristics to thus best support successful and sustained enzyme usage. Such examples do not only demonstrate the potential of enzyme-based applications but further, emphasize future market trends and accountability.
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Affiliation(s)
- Jackie Arnold
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26505, USA; (J.A.); (J.C.)
| | - Jordan Chapman
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26505, USA; (J.A.); (J.C.)
| | - Myra Arnold
- Department of Sociology and Anthropology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV 26505, USA;
- Department of Business Incubator, John Chambers College of Business and Economics, West Virginia University, Morgantown, WV 26505, USA
| | - Cerasela Zoica Dinu
- Department of Chemical and Biomedical Engineering, Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26505, USA; (J.A.); (J.C.)
- Correspondence:
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Lakoh S, García-Tardón N, Adekanmbi O, van der Valk M, Smith SJ, Grobusch MP. Prevalence of viral hepatitis B and C in Sierra Leone-current knowledge and knowledge gaps: a narrative review. Trans R Soc Trop Med Hyg 2021; 115:1106-1113. [PMID: 33772308 PMCID: PMC8486739 DOI: 10.1093/trstmh/trab054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/21/2020] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
There are no comprehensive data on viral hepatitis from Sierra Leone; however, a huge disease burden has been observed in different subpopulations. This review summarizes available data on hepatitis B and C virus (HBV and HCV) prevalence in Sierra Leone and identifies knowledge gaps. Despite the non-uniformity of the studies and the lack of systematic case recording, different reports published in recent decades yielded a hepatitis B prevalence of 8.7% among healthcare workers, 11.3% among pregnant women, 15.2% among blood donors and 16.7% in school-age children. The actual HBV prevalence in the general population was reported as 21.7%; similar to what was reported for people living with human immunodeficiency virus (PLHIV). HCV prevalence is 8% and 7% in male and female blood donors, respectively, 4.1% in PLHIV and 2.0% in school children. There are significant knowledge gaps regarding the prevalence of viral hepatitis B and C in Sierra Leone, despite the high burden reported in a few studies. There are limited programmatic interventions on the control and prevention of viral hepatitis in the country. Therefore, well-structured representative studies should provide a solid understanding of the true prevalence of hepatitis B and C to inform best possible public health measures in Sierra Leone.
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Affiliation(s)
- Sulaiman Lakoh
- Department of Internal Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Noemí García-Tardón
- Masanga Medical Research Unit, Masanga, Sierra Leone
- Department of Clinical Chemistry, Isala Hospital, Zwolle, The Netherlands
| | - Olukemi Adekanmbi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Marc van der Valk
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection & Immunity, Amsterdam Public Health, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Samuel J Smith
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- Department of Community Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Martin P Grobusch
- Masanga Medical Research Unit, Masanga, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Infection & Immunity, Amsterdam Public Health, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Fasola FA, Fowotade AA, Faneye AO. Assessment of hepatitis B surface antigen negative blood units for HBV DNA among replacement blood donors in a hospital based blood bank in Nigeria. Afr Health Sci 2021; 21:1141-1147. [PMID: 35222576 PMCID: PMC8843254 DOI: 10.4314/ahs.v21i3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hepatitis B virus infection is one of the greatest threats to blood safety all over the world. The laboratory algorithm based on only the detection of hepatitis B surface antigen (HBsAg) leaves a gap for infected HBsAg negative donors to donate blood during the “window period” (WP) and late stages of infection. Objective To estimate the frequency of the presence of HBV deoxyribonucleic acid (DNA) in HBsAg negative blood units screened using two different assays for HBsAg in a high endemic region. Methods Frozen serum aliquot of 100 replacement blood donors who donated blood units that were HBsAg negative were retrieved and tested for HBV DNA. Sample positive for HBV DNA was sequenced by Sanger's method, genotyped and the viral load was determined. Results One sample (1%) was positive for HBV DNA. The HBV viral load of the sample was 768,000 IU/ml. The partial S-gene of the Hepatitis B virus isolated was genotype E using the NCBI viral genotyping tool. Conclusions There is still a risk of HBV infected blood unit escaping detection when donor testing is limited to HBsAg screening. The use of NAT which can substantially reduce HBV infected blood donors from the donor pool should be considered.
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Affiliation(s)
- Foluke Atinuke Fasola
- Department of Haematology, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Adeola A Fowotade
- Department of Medical microbiology & Parasitology, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Adedayo O Faneye
- Department of Virology, College of Medicine, University of Ibadan, University College Hospital, Ibadan, Nigeria
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11
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Gao E, Hercun J, Heller T, Vilarinho S. Undiagnosed liver diseases. Transl Gastroenterol Hepatol 2021; 6:28. [PMID: 33824932 DOI: 10.21037/tgh.2020.04.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
The landscape of chronic liver disease has drastically changed over the past 20 years, largely due to advances in antiviral therapy and the rise of metabolic syndrome and associated non-alcoholic fatty liver disease (NAFLD). Despite advances in the diagnosis and treatment of a variety of liver diseases, the burden of chronic liver disease is increasing worldwide. The first step to addressing any disease is accurate diagnosis. Here, we discuss liver diseases that remain undiagnosed, either because they are difficult to diagnose or due to hepatic manifestations of an unrecognized systemic disease. Additionally, their underlying etiology may remain unknown or they represent previously uncharacterized and therefore novel liver diseases. Our goal is to provide a framework for approaching undiagnosed liver diseases which elude standard hepatic diagnostic work-up and whose patterns of disease are often overlooked.
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Affiliation(s)
- Emily Gao
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Julian Hercun
- Translational Hepatology Section, National Institute of Diabetes & Digestive & Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Theo Heller
- Translational Hepatology Section, National Institute of Diabetes & Digestive & Kidney Diseases, National Institute of Health, Bethesda, MD, USA
| | - Sílvia Vilarinho
- Department of Internal Medicine, Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA
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12
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Hu Y, Walter SD, Hepworth G. Estimating proportions by group retesting with unequal group sizes at each stage. COMMUN STAT-THEOR M 2021. [DOI: 10.1080/03610926.2021.1900253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Yusang Hu
- Mathematics and Statistics, McMaster University, Hamilton, ON, Canada
| | - S. D. Walter
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Graham Hepworth
- Mathematics & Statistics, The University of Melbourne, Melbourne, VIC, Australia
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13
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Ayana DA, Mulu A, Mihret A, Seyoum B, Aseffa A, Howe R. Occult Hepatitis B virus infection among HIV negative and positive isolated anti-HBc individuals in eastern Ethiopia. Sci Rep 2020; 10:22182. [PMID: 33335238 PMCID: PMC7747707 DOI: 10.1038/s41598-020-79392-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/02/2020] [Indexed: 01/05/2023] Open
Abstract
The absence of hepatitis B surface antigen (HBsAg) and the presence of antibody to hepatitis B core antigen (anti-HBc) in the blood of apparently healthy individuals may not indicate the absence of circulating hepatitis B virus (HBV) and might be infectious. Despite the risk of HBV transmission, there has been no report from Ethiopia examining this issue; therefore, this study determined occult HBV infection (OBI) among isolated anti-HBc (IAHBc) HIV negative and HIV positive individuals on ART in eastern Ethiopia. A total of 306 IAHBc individuals were included in this study. DNA was extracted, amplified, and detected from plasma using a commercially available RealTime PCR platform (Abbott m2000rt) following the manufacturer's instructions. Data were entered into EPI Data version 3.1, cleaned, and analyzed using Stata version 13. Descriptive analysis was used to calculate prevalence, summarize sociodemographic data and other factors. From the 306 IAHBc individuals (184 HIV positive and 122 HIV negative) included in the study, 183 (59.8%) were female of which 142 (77.6%) were within the reproductive age group. DNA extraction, amplified and detection was conducted in 224 individuals. The overall OBI prevalence was 5.8% (5.6% in HIV negative and 6% in HIV positive) among the IAHBc individuals. The HBV DNA concentration among the occult hepatitis B individuals was < 200 IU/mL, indicating a true occult. This study reported the burden of OBI, which pauses a significant public health problem due to the high burden of HBV infection in the country. OBI may cause substantial risk of HBV transmission from blood transfusion, organ transplantation as well as vertical transmission as screening is solely dependent on HBsAg testing.
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Affiliation(s)
- Desalegn Admassu Ayana
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia.
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - A Mulu
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - A Mihret
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - B Seyoum
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - A Aseffa
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - R Howe
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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14
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Chandrasekar A, Paulus U, Bokhorst A, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, van Kraaij M, Merz EM, van den Hurk K, Hansen MB, Slot E, Ullum H. How donor selection criteria can be evaluated with limited scientific evidence: lessons learned from the TRANSPOSE project. Vox Sang 2020; 116:342-350. [PMID: 33191514 DOI: 10.1111/vox.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Donor selection criteria (DSC) are a vital link in the chain of supply of Substances of Human Origin (SoHO) but are also subject to controversy and differences of opinion. Traditionally, DSC have been based on application of the precautionary principle. MATERIALS AND METHODS From 2017 to 2020, TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors), a European research project, aimed to identify discrepancies between current DSC by proposing a standardized risk assessment method for all SoHO (solid organs excluded) and all levels of evidence. RESULTS The current DSC were assessed using a modified risk assessment method based on the Alliance of Blood Operators' Risk-based decision-making framework for blood safety. It was found that with limited or diverging scientific evidence, it was difficult to reach consensus and an international standardized method for decision-making was lacking. Furthermore, participants found it hard to disregard their local guidelines when providing expert opinion, which resulted in substantial influence on the consensus-based decision-making process. CONCLUSIONS While the field of donation-safety research is expanding rapidly, there is an urgent need to formalize the decision-making process regarding DSC. This includes the need for standardized methods to increase transparency in the international decision-making process and to ensure that this is performed consistently. Our framework provides an easy-to-implement approach for standardizing risk assessments, especially in the context of limited scientific evidence.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Livia Cannata
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | | | | | | | - Arlinke Bokhorst
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | | | - Eva-Maria Merz
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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15
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, Pozenel P, van Kraaij M, Hansen MB, Slot E, Ullum H. Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors? Vox Sang 2020; 116:313-323. [PMID: 33103801 DOI: 10.1111/vox.13014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks. MATERIALS AND METHODS National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence. RESULTS Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available. CONCLUSIONS These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, Berne and University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | - Livia Cannata
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | | | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Primoz Pozenel
- Blood transfusion Center of Slovenia, Ljubljana, Slovenia
| | | | - Morten Bagge Hansen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Henrik Ullum
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
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16
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Beverly A, Ong G, Doree C, Welton NJ, Estcourt LJ. Drugs to reduce bleeding and transfusion in major open vascular or endovascular surgery: a systematic review and network meta-analysis. Hippokratia 2020. [DOI: 10.1002/14651858.cd013649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anair Beverly
- Systematic Review Initiative; NHS Blood and Transplant; Oxford UK
| | - Giok Ong
- Systematic Review Initiative; NHS Blood and Transplant; Oxford UK
| | - Carolyn Doree
- Systematic Review Initiative; NHS Blood and Transplant; Oxford UK
| | - Nicky J Welton
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
| | - Lise J Estcourt
- Haematology/Transfusion Medicine; NHS Blood and Transplant; Oxford UK
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17
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Xu T, Yi ZM, Luo JM, Yu HL, Fan YH, Lu H, Zhao SM, Jiang TL. Prevalence and trends of transfusion-transmittable infections among blood donors in Southwest China. J Public Health (Oxf) 2020; 41:55-61. [PMID: 29351630 DOI: 10.1093/pubmed/fdx189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/25/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The high prevalence of transfusion-transmitted infections (TTIs) is causing serious harm to human health worldwide. The aim of this research was to assess the prevalence and influencing factors of TTIs in Southwest China. METHODS A retrospective study of blood donor records from January 2008 to December 2015 was conducted. All samples were screened for HBV, HCV, HIV and syphilis. The donor's data was recorded and analyzed statistically using SPSS software. RESULTS We revealed that the prevalence of TTIs showed a decreasing trend from 2.39 to 1.98%, and this was slightly lower than that in other regions of China. Syphilis infection was the most serious issue among blood donors in Southwest China, which demonstrated a significantly higher rate than that in other areas of China. The high infection rate of the female and farmer groups in rural regions is worth noting. The logistic regression model showed that age, occupation and donor category was the influential factors for TTIs. CONCLUSIONS The overall prevalence of TTIs demonstrated a decreasing trend from 2008 to 2015 in Southwest China, but there is still a sufficient threat to blood safety, and more efforts are needed to further guarantee blood safety in China.
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Affiliation(s)
- Ting Xu
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - Zhong-Mei Yi
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - Jun-Mei Luo
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - He-Lian Yu
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - Ya-Han Fan
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - Hua Lu
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - Shu-Ming Zhao
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
| | - Tian-Lun Jiang
- Department of Transfusion Medicine, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Street, Shapingba District, Chongqing, China
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18
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Hernández-Romano P, Hernández-Romano J, Torres-Hernández RM, González-Jiménez B, López-Balderas N. Occult hepatitis B infections and anti-HBc prevalence at a resource-limited blood bank in Mexico. Transfus Med 2020; 30:396-400. [PMID: 32250006 DOI: 10.1111/tme.12681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To identify blood donors with occult hepatitis B infections (OBIs), determine the prevalence of antibody to hepatitis B core antigen (anti-HBc) positivity and estimate the impact of anti-HBc screening on donor deferral at CETS-Veracruz (Mexico). BACKGROUND Hepatitis B virus infection is a major concern in transfusion medicine. Mexican regulations only mandate screening for hepatitis B surface antigen (HBsAg), and there are no requirements regarding testing for anti-HBc or use of a nucleic acid test (NAT). There is, therefore, limited information about the prevalence of anti-HBc positivity and occult hepatitis B among blood donors in Mexico. METHODS This retrospective study examined individuals who donated blood to CETS-Veracruz from June 2014 to June 2017. All donors were serologically examined according to Mexican health regulations, and the prevalence of anti-HBc positivity was determined. A NAT was used to identify individuals with OBIs. RESULTS We analysed the data of 28 016 blood donors. Over 4 years, the average prevalence of anti-HBc positivity was 1.05%. The risk factors for anti-HBc positivity were low education and age over 50 years. There were nine donors with OBIs. CONCLUSION The presence of donors with OBIs in CETS-Veracruz and other Mexican blood banks highlights the need to mandate the implementation of anti-HBc screening in Mexico.
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Affiliation(s)
- Pablo Hernández-Romano
- Centro Estatal de la Transfusión Sanguínea del Estado de Veracruz, Veracruz, Mexico.,Facultad de Bioanálisis, Región Veracruz, Universidad Veracruzana, Veracruz, Mexico
| | - Jesús Hernández-Romano
- Universidad Politécnica del Estado de Morelos, Departamento de Biotecnología, Jiutepec, Mexico
| | - Rosa M Torres-Hernández
- UV-CA477 "Investigación Clínica" Facultad de Medicina, Región Veracruz, Universidad Veracruzana, Veracruz, Mexico
| | - Beatriz González-Jiménez
- UV-CA477 "Investigación Clínica" Facultad de Medicina, Región Veracruz, Universidad Veracruzana, Veracruz, Mexico
| | - Nayali López-Balderas
- UV-CA477 "Investigación Clínica" Facultad de Medicina, Región Veracruz, Universidad Veracruzana, Veracruz, Mexico.,Instituto de Medicina Forense, Departamento de Genética Forense, Universidad Veracruzana, Boca del Río, Mexico
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19
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Atilola G, Tomisin O, Randle M, Isaac KO, Odutolu G, Olomu J, Adenuga L. Epidemiology of HBV in Pregnant Women, South West Nigeria. J Epidemiol Glob Health 2019; 8:115-123. [PMID: 30864752 PMCID: PMC7377572 DOI: 10.2991/j.jegh.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/04/2018] [Accepted: 09/03/2018] [Indexed: 12/28/2022] Open
Abstract
Hepatitis B virus (HBV) remains a leading cause of chronic hepatitis, maternal complications, and neonatal deaths in sub-Saharan Africa. Pregnant women serve as a major reservoir for the persistence and ongoing transmission of hepatitis B virus and HIV in a generalized heterosexual epidemic. The aim of this study is to assess the epidemiology of Hepatitis B infection among pregnant women in South West-Nigeria. This is a cross-sectional study of 353 pregnant women across 10 health facilities in the region. Results showed that of the 353 pregnant women tested, 37 were positive for the HBV antigen giving a prevalence estimate of 10.5% (95% CI: 7.5%–14.2%). We found significant negative association between odds of HBV infection and knowledge of HBV transmission through sex (OR: 0.30: 95%CI–0.11–0.82) and a positive association with blood transfusion in the past three months (OR: 9.5: 95% CI-1.58–57.14). Findings strongly suggest high endemicity of HBV and the possible implication of blood transfusion as a major route of ongoing HBV transmission among pregnant women in south-western Nigeria. We recommend further study of a prospective design to investigate the possible causal link between blood transfusion and the risk of HBV infection among pregnant women in Nigeria.
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Affiliation(s)
- Glory Atilola
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria.,Department of Mathematics and Statistics, Northumbria University, Newcastle Upon Tyne, UK
| | - Obadara Tomisin
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
| | - Mayowa Randle
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
| | - Komolafe O Isaac
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
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20
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Beverly A, Ong G, Wilkinson KL, Doree C, Welton NJ, Estcourt LJ. Drugs to reduce bleeding and transfusion in adults undergoing cardiac surgery: a systematic review and network meta-analysis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Anair Beverly
- NHS Blood and Transplant; Systematic Review Initiative; Oxford UK
| | - Giok Ong
- NHS Blood and Transplant; Systematic Review Initiative; Oxford UK
| | - Kirstin L Wilkinson
- Southampton University NHS Hospital; Paediatric and Adult Cardiothoracic Anaesthesia; Tremona Road Southampton UK SO16 6YD
| | - Carolyn Doree
- NHS Blood and Transplant; Systematic Review Initiative; Oxford UK
| | - Nicky J Welton
- University of Bristol; Population Health Sciences, Bristol Medical School; Bristol UK
| | - Lise J Estcourt
- NHS Blood and Transplant; Haematology/Transfusion Medicine; Level 2, John Radcliffe Hospital Headington Oxford UK OX3 9BQ
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21
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Evaluation of occult hepatitis B infection in tissue donors: a multicenter analysis in Spain. Cell Tissue Bank 2019; 20:513-526. [PMID: 31451994 DOI: 10.1007/s10561-019-09784-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/21/2019] [Indexed: 12/31/2022]
Abstract
Traditionally, when antibody to the Hepatitis B core antigen (anti-HBc) and antibody to the Hepatitis B surface antigen (anti-HBs) are positive, the donor is considered suitable. However, the literature contains cases with this profile and circulating hepatitis B virus DNA. The aim of the study is to analyze the incidence of occult hepatitis B virus infection (OBI). Retrospective data were evaluated for deceased tissue donors in ten Tissue Establishments (Spain) during 2017. The data included demographic data and the serological markers for hepatitis B that each tissue establishment performed. A total number of 1933 tissue donors were evaluated. A total of 180 donors were excluded: 6 (0.3%) with Hepatitis B surface antigen (HBs positive), and 174 in which DNA testing was not performed. Anti-HBc was positive in 175 donors (10%), in which anti-HBs was negative in 30 (17.1%) and positive in 145 (82.9%). In total, 27 donors with DNA positive (1.5%) were found, of which 3 of 117 donors (1.7%) showed anti-HBc negative and anti-HBs positive (> 10 IU/ml), 4 of 30 donors (13.3%) showed anti-HBc positive and anti-HBs negative and 20 of 145 donors (13.8%) showed both anti-HBc and anti-HBs positive. The highest probability of finding DNA occurs when anti-HBc is positive, regardless of the presence of anti-HBs. In our study, the probability of OBI was 1.5%. The classic concept that when anti-HBc and anti-HBs are positive (even with a titer of over 100 IU/ml) the donor can be accepted should, therefore, be reconsidered, and DNA testing should be mandatory.
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22
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Seed CR, Allain J, Lozano M, Laperche S, Gallian P, Gross S, Kwon S, Oh E, Kim J, Chua SS, Lam S, Ang AL, Tsoi W, Hewitt PE, Davison KL, Tettmar K, O'Flaherty N, Boland F, Williams P, Pomeroy L, Wendel S, Fachini R, Scuracchio P, Carminato P, Fearon M, O'Brien SF, Delage G, Kiely P, Hoad V, Matsubayashi K, Satake M, Taira R, Stramer SL, Sauleda S, Bes M, Piron M, El Ekiaby M, Vermeulen M, Levičnik Stezinar S, Nograšek P, Jarvis LM, Petrik J, Charlewood R, Flanagan P, Grabarczyk P, Kopacz A, Łętowska M, Seifried E, Schmidt M. International Forum on Occult hepatitis B infection and transfusion safety. Vox Sang 2019; 114:e1-e35. [DOI: 10.1111/vox.12743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | - Syria Laperche
- Institut National de la Transfusion Sanguine Département des agents transmissibles par le sang Centre National de Référence Risques Infectieux Transfusionnels 6 rue Alexandre Cabanel Paris 75015 France
| | - Pierre Gallian
- Etablissement Français du Sang 20 Avenue du Stade de France La Plaine Saint‐Denis 93218 France
| | - Sylvie Gross
- Etablissement Français du Sang 20 Avenue du Stade de France La Plaine Saint‐Denis 93218 France
| | - So‐Yong Kwon
- Jungbu Blood Laboratory Center Korean Red Cross 22 Songchonam‐ro, Daedeok‐gu Daejeon Korea
| | - E.Y. Oh
- Jungbu Blood Laboratory Center Korean Red Cross 22 Songchonam‐ro, Daedeok‐gu Daejeon Korea
| | - J.N. Kim
- Division of Human Blood Safety Surveillance Korea Centers for Disease Control and Prevention Osong Korea
| | - Sze Sze Chua
- Health Sciences Authority Blood Services Group 11 Outram Road Singapore 169078 Singapore
| | - Sally Lam
- Health Sciences Authority Blood Services Group 11 Outram Road Singapore 169078 Singapore
| | - Ai Leen Ang
- Health Sciences Authority Blood Services Group 11 Outram Road Singapore 169078 Singapore
| | - Wai‐Chiu Tsoi
- Hong Kong Red Cross Blood Transfusion Service 15 King's Park Rise Kowloon Hong Kong China
| | | | - Katy L. Davison
- NHS Blood and Transplant Public Health England Epidemiology Unit Colindale Avenue Colindale UK
| | - Kate Tettmar
- NHS Blood and Transplant Colindale Centre Charcot Road Colindale UK
| | - Niamh O'Flaherty
- Irish Blood Transfusion Service National Blood Centre St. James's Gate Dublin 8 Ireland
| | - Fiona Boland
- Irish Blood Transfusion Service National Blood Centre St. James's Gate Dublin 8 Ireland
| | - Padraig Williams
- Irish Blood Transfusion Service National Blood Centre St. James's Gate Dublin 8 Ireland
| | - Louise Pomeroy
- Irish Blood Transfusion Service National Blood Centre St. James's Gate Dublin 8 Ireland
| | - Silvano Wendel
- Hospital Sirio Libanês Rua Adma Jafet 91 São Paulo 01308‐050 Brasil
| | - Roberta Fachini
- Hospital Sirio Libanês Rua Adma Jafet 91 São Paulo 01308‐050 Brasil
| | | | | | | | | | - Gilles Delage
- Héma Québec 4045 boul. Cote‐Vertu ville Saint Laurent QC Canada
| | - Philip Kiely
- Australian Red Cross Blood Service 100‐154 Batman Street West Melbourne VIC 3003 Australia
| | - Veronica Hoad
- Australian Red Cross Blood Service 290 Wellington Street Perth WA 6000 Australia
| | - Keiji Matsubayashi
- Central Blood Institute Blood Service Headquarters Japanese Red Cross Society 2‐1‐67 Tatsumi, Koto‐ku Tokyo Japan
| | - Masahiro Satake
- Central Blood Institute Blood Service Headquarters Japanese Red Cross Society 2‐1‐67 Tatsumi, Koto‐ku Tokyo Japan
| | - Rikizo Taira
- Technical Department Blood Service Headquarters Japanese Red Cross Society 1‐2‐1 Shibakoen, Minato‐ku Tokyo Japan
| | | | - Silvia Sauleda
- Transfusion Safety Laboratory Banc de Sang i Teixits Doctor Frederic Duran i Jorda Building, Passeig Taulat, 116 08005 Barcelona Spain
| | - Marta Bes
- Transfusion Safety Laboratory Banc de Sang i Teixits Doctor Frederic Duran i Jorda Building, Passeig Taulat, 116 08005 Barcelona Spain
| | - Maria Piron
- Transfusion Safety Laboratory Banc de Sang i Teixits Doctor Frederic Duran i Jorda Building, Passeig Taulat, 116 08005 Barcelona Spain
| | - Magdy El Ekiaby
- Shabrawishi Hospital Blood Transfusion Centre Finni Square Dokki, Giza Egypt
| | - Marion Vermeulen
- The South African National Blood Service 1 Constantia Boulevard, ConstantiaKloof Roodepoort, Gauteng South Africa
| | | | - Polona Nograšek
- Blood Transfusion Centre of Slovenia Šlajmerjeva 6 SI‐1000 Ljubljana Slovenia
| | - Lisa M. Jarvis
- Scottish National Blood Transfusion Service The Jack Copland Centre 52 Research Avenue North Edinburgh EH14 4BE UK
| | - Juraj Petrik
- Scottish National Blood Transfusion Service The Jack Copland Centre 52 Research Avenue North Edinburgh EH14 4BE UK
| | - Richard Charlewood
- New Zealand Blood Service 71 Great South Road Epsom, Auckland New Zealand
| | - Peter Flanagan
- New Zealand Blood Service 71 Great South Road Epsom, Auckland New Zealand
| | - Piotr Grabarczyk
- Department of Virology Institute of Hematology and Transfusion Medicine Gandhi Str. 14th 02 776 Warsaw Poland
| | - Aneta Kopacz
- Department of Virology Institute of Hematology and Transfusion Medicine Gandhi Str. 14th 02 776 Warsaw Poland
| | - Magdalena Łętowska
- Department of Transfusion Institute of Hematology and Transfusion Medicine Gandhi Str. 14th 02 776 Warsaw Poland
| | - Erhard Seifried
- German Red Cross Institute for Transfusion medicine and Immunohematology German Red Cross Baden‐Wuerrtemberg – Hesse Goethe University Frankfurt Sandhof Street 1 60528 Frankfurt
| | - Michael Schmidt
- German Red Cross Institute for Transfusion medicine and Immunohematology German Red Cross Baden‐Wuerrtemberg – Hesse Goethe University Frankfurt Sandhof Street 1 60528 Frankfurt
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Determination of Varying Group Sizes for Pooling Procedure. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:4381084. [PMID: 31065292 PMCID: PMC6466917 DOI: 10.1155/2019/4381084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 11/17/2022]
Abstract
Pooling is an attractive strategy in screening infected specimens, especially for rare diseases. An essential step of performing the pooled test is to determine the group size. Sometimes, equal group size is not appropriate due to population heterogeneity. In this case, varying group sizes are preferred and could be determined while individual information is available. In this study, we propose a sequential procedure to determine varying group sizes through fully utilizing available information. This procedure is data driven. Simulations show that it has good performance in estimating parameters.
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Armas Cayarga A, Perea Hernández Y, González González YJ, Figueredo Lago JE, Valdivia Álvarez IY, Gómez Cordero I, Santos Hernández N, Vega Sánchez H, La Rosa Hernández D, Martínez Pérez EL. Performance characteristics of a fast real-time PCR assay for hepatitis B virus DNA quantification. Biologicals 2019; 58:22-27. [PMID: 30718130 DOI: 10.1016/j.biologicals.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 12/17/2018] [Accepted: 01/08/2019] [Indexed: 12/26/2022] Open
Abstract
Detection of hepatitis B virus (HBV) DNA is particularly important for detection of early acute and of occult HBV infection. On the other hand, HBV DNA detection and quantification are essential to diagnose and treat chronic HBV infection. In this study, we evaluated the performance of the real-time PCR SUMASIGNAL VHB (un paso) (Immunoassay Center, Cuba). The clinical and analytical specificity of the assay was 100%. Intra-assay and inter-assay coefficients of variation ranged from 0.50 to 2.53% and from 1.23 to 3.03%, respectively. A strong correlation (r=0.926; P<0.001) with the COBAS® AmpliPrep/COBAS® TaqMan® HBV Test, v2.0 (Roche Molecular Systems, Inc.) was obtained. The limit of detection using the third WHO international standard for HBV DNA was 377.47 IU/mL. The test was able to detect the most prevalent HBV genotypes (A-G) equally well. In conclusion, the SUMASIGNAL VHB (un paso) is a sensitive, specific, precise and accurate assay for the quantification of serum and plasma HBV DNA. Thus, this simple and fast real-time PCR test can be used as an aid in diagnosing an HBV infection and monitoring drug efficacy.
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Affiliation(s)
- Anny Armas Cayarga
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba.
| | - Yenitse Perea Hernández
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba
| | - Yaimé J González González
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba
| | - Juan E Figueredo Lago
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba
| | - Irinia Y Valdivia Álvarez
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba
| | - Ivonne Gómez Cordero
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba
| | - Niurka Santos Hernández
- National Institute of Gastroenterology (IGE), Havana, Cuba, Calle 25 No. 503 e/ H e I, Plaza de la Revolución, La Habana, CP 10400, Cuba
| | - Héctor Vega Sánchez
- National Institute of Gastroenterology (IGE), Havana, Cuba, Calle 25 No. 503 e/ H e I, Plaza de la Revolución, La Habana, CP 10400, Cuba
| | - Deyanira La Rosa Hernández
- National Institute of Gastroenterology (IGE), Havana, Cuba, Calle 25 No. 503 e/ H e I, Plaza de la Revolución, La Habana, CP 10400, Cuba
| | - Ernesto L Martínez Pérez
- Molecular Biology Department, Centro de InmunoEnsayo (CIE), Calle 134 y Avenida 25 Playa, Apartado Postal 6653, La Habana, CP 11600, Cuba
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25
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Ramachandran S, Groves JA, Xia GL, Saá P, Notari EP, Drobeniuc J, Poe A, Khudyakov N, Schillie SF, Murphy TV, Kamili S, Teo CG, Dodd RY, Khudyakov YE, Stramer SL. Recent and occult hepatitis B virus infections among blood donors in the United States. Transfusion 2019; 59:601-611. [PMID: 30499591 PMCID: PMC8190636 DOI: 10.1111/trf.15057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Characteristics of US blood donors with recent (RBI) or occult (OBI) hepatitis B virus (HBV) infection are not well defined. METHODS Donors with RBI and OBI were identified by nucleic acid and serologic testing among 34.4 million donations during 2009-2015. Consenting donors were interviewed and their HBV S-gene sequenced. RESULTS The overall rate of HBV-infected donors was 7.95 per 100,000; of these, 0.35 per 100,000 and 1.70 per 100,000 were RBI and OBI, respectively. RBI (n = 120) and OBI (n = 583) donors constituted 26% of all HBV-infected (n = 2735) donors. Detection of HBV DNA in 92% of OBI donors required individual donation nucleic acid testing. Donors with OBI compared to RBI were older (mean age, 48 vs 39 years; p < 0.0001) with lower median viral loads (9 vs. 529 IU/mL; p < 0.0001). A higher proportion of OBI than RBI donors were born or resided in an endemic country (39% vs. 5%; p = 0.0078). Seventy-seven percent of all RBI and OBI donors had multiple sex partners, an HBV-risk factor. Of 40 RBI and 10 OBI donors whose S gene was sequenced, 33 (83%) and 6 (60%), respectively, carried HBV subgenotype A2; 18 (55%) and 2 (33%), respectively, shared an identical sequence. Infection with 1 or more putative HBV-immune-escape mutants was identified in 5 (50%) of OBI but no RBI donors. CONCLUSION RBI and OBI continue to be identified at low rates, confirming the importance of comprehensive HBV DNA screening of US blood donations. HBV-infected donors require referral for care and evaluation and contact tracing; their HBV strains may provide important information on emergent genotypes.
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Affiliation(s)
- Sumathi Ramachandran
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jamel A. Groves
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | - Guo-liang Xia
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paula Saá
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | | | - Jan Drobeniuc
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amanda Poe
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah F. Schillie
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trudy V. Murphy
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Saleem Kamili
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chong-Gee Teo
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Roger Y. Dodd
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | - Yury E. Khudyakov
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Transmission of Hepatitis B and D Viruses in an African Rural Community. mSystems 2018; 3:mSystems00120-18. [PMID: 30246145 PMCID: PMC6143728 DOI: 10.1128/msystems.00120-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022] Open
Abstract
According to the World Health Organization (WHO), an estimated 257 million people worldwide are chronically infected with hepatitis B virus (HBV), with approximately 15 million of them being coinfected with hepatitis D virus (HDV). To investigate the prevalence and transmission of HBV and HDV within the general population of a rural village in Cameroon, we analyzed serum samples from most (401/448) of the villagers. HBV surface antigen (HBsAg) was detected in 54 (13.5%) of the 401 samples, with 15% of them also containing anti-HDV antibodies. Although Cameroon has integrated HBV vaccination into their Expanded Program on Immunization for newborns in 2005, an HBsAg carriage rate of 5% was found in children below the age of 5 years. Of the 54 HBsAg-positive samples, 49 HBV pre-S/S sequences (7 genotype A and 42 genotype E sequences) could be amplified by PCR. In spite of the extreme geographical restriction in the recruitment of study participants, a remarkable genetic diversity within HBV genotypes was observed. Phylogenetic analysis of the sequences obtained from PCR products combined with demographic information revealed that the presence of some genetic variants was restricted to members of one household, indicative of intrafamilial transmission, which appears to take place at least in part perinatally from mother to child. Other genetic variants were more widely distributed, reflecting horizontal interhousehold transmission. Data for two households with more than one HBV-HDV-coinfected individual indicate that the two viruses are not necessarily transmitted together, as family members with identical HBV sequences had different HDV statuses. IMPORTANCE This study revealed that the prevalence of HBV and HDV in a rural area of Cameroon is extremely high, underlining the pressing need for the improvement of control strategies. Systematic serological and phylogenetic analyses of HBV sequences turned out to be useful tools to identify networks of virus transmission within and between households. The high HBsAg carriage rate found among children demonstrates that implementation of the HBV birth dose vaccine and improvement of vaccine coverage will be key elements in preventing both HBV and HDV infections. In addition, the high HBsAg carriage rate in adolescents and adults emphasizes the need for identification of chronically infected individuals and linkage to WHO-recommended treatment to prevent progression to liver cirrhosis and hepatocellular carcinoma.
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27
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Brook G, Brockmeyer N, van de Laar T, Schellberg S, Winter AJ. 2017 European guideline for the screening, prevention and initial management of hepatitis B and C infections in sexual health settings. Int J STD AIDS 2018; 29:949-967. [PMID: 29716442 DOI: 10.1177/0956462418767576] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This guideline updates the 2010 European guideline for the management of hepatitis B and C virus infections. It is primarily intended to provide advice on testing, prevention and initial management of viral hepatitis B and C for clinicians working in sexual health clinical settings in European countries. The guideline is in a new question and answer format based on clinical situations, from which population/intervention/comparison/outcome questions were formulated. Updates cover areas such as epidemiology, point-of-care tests for hepatitis B, hepatitis C risk and 'chemsex', and HIV pre-exposure prophylaxis and hepatitis B. We have also included a short paragraph on hepatitis E noting there is no evidence for sexual transmission. The guideline has been prepared in accordance with the Europe protocol for production available at http://www.iusti.org/regions/europe/pdf/2017/ProtocolForProduction2017.pdf.
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Affiliation(s)
- Gary Brook
- 1 Genitourinary Medicine, London North West Healthcare NHS Trust, London, UK
| | - Norbert Brockmeyer
- 2 Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Germany
| | - Thijs van de Laar
- 3 Department of Bloodborne Infections, Sanquin Blood Supply, Amsterdam, Netherlands
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28
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Lunn RM, Jahnke GD, Rabkin CS. Tumour virus epidemiology. Philos Trans R Soc Lond B Biol Sci 2018; 372:rstb.2016.0266. [PMID: 28893933 DOI: 10.1098/rstb.2016.0266] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 02/06/2023] Open
Abstract
A viral etiology of cancer was first demonstrated in 1911 by Peyton Rous who injected cell-free filtrate from a chicken sarcoma into healthy chickens and found it induced a tumour. Since the discovery over 50 years ago of the Epstein-Barr virus as the cause of Burkitt lymphoma, seven other human viruses or groups of viruses-hepatitis B virus, hepatitis C virus, human immunodeficiency virus type 1, some human papillomaviruses, human T-cell lymphotropic virus type 1, Kaposi sarcoma-associated herpesvirus and Merkel cell polyomavirus-have been linked to human cancer. Collectively, these eight viruses cause over 20 different types of cancer and contribute to 10-12% of all cancer, with a greater burden in low- and middle-income countries. For many viruses, immunosuppression greatly increases the risks of persistent infection, development of chronic sequelae and cancer. Although several viruses share similar routes of transmission (especially sexual activity, injection drug use and mother-to-child transmission), the predominant route of transmission varies across viruses, and for the same virus can vary by geographical location. In general, vulnerable populations at the greatest risk for viral infections and their associated diseases include people, especially children, living in low- to middle-income countries, men who have sex with men, people who use injection drugs and female sex workers.This article is part of the themed issue 'Human oncogenic viruses'.
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Affiliation(s)
- Ruth M Lunn
- Office of the Report on Carcinogens, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
| | - Gloria D Jahnke
- Office of the Report on Carcinogens, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709, USA
| | - Charles S Rabkin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-9760, USA
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29
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Atilola G, Tomisin O, Randle M, Isaac KO, Odutolu G, Olomu J, Adenuga L. Epidemiology of HBV in Pregnant Women, South West Nigeria. J Epidemiol Glob Health 2018. [DOI: 10.1016/j.jegh.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Glory Atilola
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
- Department of Mathematics and Statistics, Northumbria University, Newcastle Upon Tyne, UK
| | - Obadara Tomisin
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
| | - Mayowa Randle
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
| | - Komolafe O. Isaac
- Department of Biological Sciences, Redeemers University, Ede, Osun State, Nigeria
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30
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Ghoma Linguissi LS, Nkenfou CN. Epidemiology of viral hepatitis in the Republic of Congo: review. BMC Res Notes 2017; 10:665. [PMID: 29197421 PMCID: PMC5712139 DOI: 10.1186/s13104-017-2951-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/21/2017] [Indexed: 02/06/2023] Open
Abstract
Objective Considered an endemic zone, Republic of Congo has a high seroprevalence rate of hepatitis B and C virus. To know the extent of hepatitis infection as a public health problem, we reviewed published literature and other sources for reports of these viral infections in the country. Results High seroprevalence of HBV and HCV carriage in blood donors were observed in studies confirming Congo’s place in the hyperendemic area of HBV and HCV infection. These prevalence were compared by Chi square test. We compared the prevalence of three studies conducted in 1996, 2015 and 2016. The statistical results were very significant. HBV genotype E was most prevalent. Very few studies were done on pregnant women. Difficulties in the care and management of patients were also noted because of the high cost of often unavailable treatments. Difficulties arise, however, when an attempt was made to implement the National Hepatitis Control Program. Despite studies conducted on hepatitis prevalence, health interventions are still needed to care and manage these patients and the need to implement the national hepatitis control is more pressing in the Congo.
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Affiliation(s)
| | - Celine Nguefeu Nkenfou
- Chantal Biya International Reference Centre for Research on Prevention and Management on HIV and AIDS, Yaounde, Cameroon.,Higher Teachers Training College, University of Yaounde I, Yaounde, Cameroon
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31
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Genetic polymorphisms of HLA-DP and isolated anti-HBc are important subsets of occult hepatitis B infection in Indonesian blood donors: a case-control study. Virol J 2017; 14:201. [PMID: 29061159 PMCID: PMC5654084 DOI: 10.1186/s12985-017-0865-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/11/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Occult hepatitis B infection (OBI) is defined as the presence of hepatitis B virus (HBV) DNA in the serum and/or liver in HBsAg-negative individuals. OBI is associated with the risk of viral transmission, especially in developing countries, and with progressive liver disease and reactivation in immunosuppressive patients. The objective of this study was to evaluate the relation of OBI to HLA-DP single nucleotide polymorphisms (SNPs) encoding antigen-binding sites for the immune response to HBV infection. As HLA-DP variants affect the mRNA expression of HLA-DPA1 and HLA-DPB1 in the liver, we hypothesised that high levels of HLA-DPA1 and HLA-DPB1 expression favour OBI development. METHODS The study enrolled 456 Indonesian healthy blood donors (HBsAg negative). OBI was defined as the presence of HBV-DNA in at least two of four open reading frames (ORFs) of the HBV genome detected by nested PCR. SNPs in HLA-DPA1 (rs3077) and HLA-DPB1 (rs3135021, rs9277535, and rs2281388) were genotyped using real-time Taqman® genotyping assays. RESULTS Of 122 samples positive for anti-HBs and/or anti-HBc, 17 were determined as OBI. The minor allele in rs3077 was significantly correlated with OBI [odds ratio (OR) = 3.87, 95% confidence interval (CI) = 1.58-9.49, p = 0.0015]. The prevalence of the minor allele (T) was significantly higher in subjects with OBI than in those without (59% and 33%, respectively). The combination of haplotype markers (TGA for rs3077-rs3135021-rs9277535) was associated with increased risk of OBI (OR = 4.90, 95%CI = 1.12-21.52 p = 0.038). The prevalence of OBI was highest in the isolated anti-HBc group among the three seropositive categories: anti-HBs <500 mIU/ml, anti-HBs ≥500 mIU/ml, and isolated anti-HBc (29.41%, p = 0.014). CONCLUSION Genetic variants of HLA-DP and the presence of anti-HBc are important predictors of OBI in Indonesian blood donors. TRIAL REGISTRATION Ref: KE/FK/194/EC; registered 01 March 2013. Continuing approval Ref: KE/FK/536/EC; registered 12 May 2014.
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32
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Wong GLH, Wong VWS, Chan HLY. Virus and Host Testing to Manage Chronic Hepatitis B. Clin Infect Dis 2017; 62 Suppl 4:S298-305. [PMID: 27190319 DOI: 10.1093/cid/ciw024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection is a major cause of cirrhosis and hepatocellular carcinoma worldwide. The past 50 years have seen rapid developments in HBV testing. Beginning from traditional serologic tests, the availability of sensitive HBV DNA assays allows a thorough understanding of the virology and natural history of chronic HBV infection. Quantification of hepatitis B surface antigen levels reflects the amount and transcriptional activities of covalently closed circular DNA in the liver and may be used to evaluate the stage of disease and guide antiviral therapy. The natural history of chronic HBV infection is also a manifestation of the interaction between the host and the virus, and recent genomic works have shed light on the host-virus relationship and may provide novel tests in the future. This review highlights recent advances in the application of HBV tests in the management of chronic hepatitis B.
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Affiliation(s)
- Grace Lai-Hung Wong
- Department of Medicine and Therapeutics Institute of Digestive Disease State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics Institute of Digestive Disease State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics Institute of Digestive Disease State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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33
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Drew VJ, Barro L, Seghatchian J, Burnouf T. Towards pathogen inactivation of red blood cells and whole blood targeting viral DNA/RNA: design, technologies, and future prospects for developing countries. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:512-521. [PMID: 28488960 PMCID: PMC5649960 DOI: 10.2450/2017.0344-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 01/22/2023]
Abstract
Over 110 million units of blood are collected yearly. The need for blood products is greater in developing countries, but so is the risk of contracting a transfusion-transmitted infection. Without efficient donor screening/viral testing and validated pathogen inactivation technology, the risk of transfusion-transmitted infections correlates with the infection rate of the donor population. The World Health Organization has published guidelines on good manufacturing practices in an effort to ensure a strong global standard of transfusion and blood product safety. Sub-Saharan Africa is a high-risk region for malaria, human immunodeficiency virus (HIV), hepatitis B virus and syphilis. Southeast Asia experiences high rates of hepatitis C virus. Areas with a tropical climate have an increased risk of Zika virus, Dengue virus, West Nile virus and Chikungunya, and impoverished countries face economical limitations which hinder efforts to acquire the most modern pathogen inactivation technology. These systems include Mirasol® Pathogen Reduction Technology, INTERCEPT®, and THERAFLEX®. Their procedures use a chemical and ultraviolet or visible light for pathogen inactivation and significantly decrease the threat of pathogen transmission in plasma and platelets. They are licensed for use in Europe and are used in several other countries. The current interest in the blood industry is the development of pathogen inactivation technologies that can treat whole blood (WB) and red blood cell (RBC). The Mirasol system has recently undergone phase III clinical trials for treating WB in Ghana and has demonstrated some efficacy toward malaria inactivation and low risk of adverse effects. A 2nd-generation of the INTERCEPT® S-303 system for WB is currently undergoing a phase III clinical trial. Both methodologies are applicable for WB and components derived from virally reduced WB or RBC.
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Affiliation(s)
- Victor J. Drew
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
| | - Lassina Barro
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
- National Center of Blood Transfusion, Ouagadougou, Burkina Faso, United Kingdom
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality Improvement/Safety, Audit/Inspection and DDR Strategy, London, United Kingdom
| | - Thierry Burnouf
- International PhD Program of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taiwan
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Vitrone M, Iossa D, Rinaldi L, Pafundi PC, Molaro R, Parrella A, Andini R, Ragone E, Maiello C, Zampino R, Durante-Mangoni E. Hepatitis B virus reactivation after heart transplant: Incidence and clinical impact. J Clin Virol 2017; 96:54-59. [PMID: 28964958 DOI: 10.1016/j.jcv.2017.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Occult hepatitis B infection consists of persistence of HBV genomes in hepatocytes,absence of serum HBsAg, low/undetectable serum HBVDNA. Reactivation of HBV infection may occur during immunosuppression, but few data are available in heart transplant. OBJECTIVES We followed-up heart recipients with or without markers of previous HBV infection,evaluating prevalence of HBV markers, incidence of HBV reactivation and its virological and clinical features. STUDY DESIGN Heart failure patients listed for heart transplant (2007-2013) were screened for current or past HBV infection. Transplanted patients with past HBV infection (anti-HBc+/±anti-HBs+/HBVDNA-) were followed up as cases, and an equal number of HBV negative patients as controls. Virological reactivation was detected by standard real-time and home-made highly sensitive PCR (surface/core HBVDNA regions). Clinical status and progression were assessed by liver histology, ultrasound or elastography. RESULTS 67 patients underwent heart transplant, including 4 (5.9%) HBsAg+ subjects. Cases were 11/67 (16.4%). During a median follow-up of 30 months, only one of these 11 patients presented viral reactivation (HBVDNA 209IU/mL) at month 22, and started antiviral treatment. Four other recipients showed virological events of uncertain significance (sensitive PCR-only intermittently positive). Clinical signs of liver disease were observed in only one case at the last follow-up. A nonsignificant difference in survival was observed between cases and all other heart recipients without prior HBV contact (death rate 5/11 vs 15/52, respectively; p=0.097). CONCLUSIONS HBV genotypic reactivation in HBsAg-/anti-HBc+/HBVDNA- heart recipients is uncommon. Virological events of uncertain significance occur more frequently; their clinical impact seems to be negligible.
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Affiliation(s)
- Martina Vitrone
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy.
| | - Domenico Iossa
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Luca Rinaldi
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Pia Clara Pafundi
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Rosa Molaro
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Antonio Parrella
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Roberto Andini
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Enrico Ragone
- Units of Infectious & Transplant Medicine, Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Ciro Maiello
- Cardiac Surgery, AORN dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Rosa Zampino
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy; Units of Infectious & Transplant Medicine, Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
| | - Emanuele Durante-Mangoni
- Internal Medicine, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy; Units of Infectious & Transplant Medicine, Monaldi Hospital, Piazzale Ettore Ruggieri snc, 80131, Naples, Italy
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Kang JW, Seo JH, Youn KW, Seo YI, Huh K, Choi GR, Min HK, Oh DJ, Jo HJ, Kim JN. Use of supplemental anti-HBc testing of donors showing non-discriminating reactive results in multiplex nucleic acid testing. Vox Sang 2017; 112:622-627. [PMID: 28891069 DOI: 10.1111/vox.12553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES The Korean Red Cross began nucleic acid amplification testing (NAT) for HIV and HCV in February 2005, and added HBV NAT beginning in June 2012. The current NAT system utilizes a multiplex assay for simultaneous detection of HBV DNA, HCV RNA and HIV-1 RNA. For samples that are reactive in the multiplex assay, we do specific tests for each virus. However, there have been cases of non-discriminated reactive (NDR) results which appear to be the result of non-specific reactions or cross-contamination, although some cases are considered to arise from the presence of low levels of HBV DNA due to occult hepatitis B infection. MATERIALS AND METHODS We examined the incidence of NDR results in previous donations of some NAT-reactive donors. Additionally, for those donors with NDR results, we performed an HBV core antibody (anti-HBc) assay. RESULTS From November 2015 to March 2016, there were 408 NAT-reactive donors. Of these, nineteen HBV NAT-reactive donors showed a history of NDR results in the past donations. Seven donors showed NDR results more than once. Of 771 NDR donors, 362 (47·0%) were anti-HBc reactive. CONCLUSION The NDR donors had a substantially higher rate of anti-HBc reactivity than other blood donors indicating that some with anti-HBc reactivity represent donors with occult HBV. Therefore, the incorporation of an anti-HBc testing for NDR donors could improve blood safety testing for the Korean Red Cross.
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Affiliation(s)
- J W Kang
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - J H Seo
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - K W Youn
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - Y I Seo
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - K Huh
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - G R Choi
- Blood Service Headquarter, Korean Red Cross, Wonju, Korea
| | - H K Min
- Blood Service Headquarter, Korean Red Cross, Wonju, Korea
| | - D J Oh
- Blood Service Headquarter, Korean Red Cross, Wonju, Korea
| | - H J Jo
- Division of Human Blood Safety Surveillance, Korea Center for Disease Control and Prevention, Osong, Korea
| | - J N Kim
- Division of Human Blood Safety Surveillance, Korea Center for Disease Control and Prevention, Osong, Korea
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Lee KH, Shim KS, Lim IS, Chae SA, Yun SW, Lee NM, Choi YB, Yi DY. Changes in hepatitis B virus antibody titers over time among children: a single center study from 2012 to 2015 in an urban of South Korea. BMC Pediatr 2017; 17:164. [PMID: 28705230 PMCID: PMC5512724 DOI: 10.1186/s12887-017-0924-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/05/2017] [Indexed: 12/24/2022] Open
Abstract
Background Hepatitis B virus (HBV) infection is the most common cause of liver disease in endemic areas such as South Korea. After HBV vaccination, hepatitis B surface antibody (HBsAb) titers gradually decrease. Trends in HBsAb titers have not been evaluated among children in South Korea over the past decade. Methods We screened 6155 patients (aged 7 months to 17 years) who underwent HBV antigen/antibody testing at Chung-Ang University Hospital from May 2012 to April 2015. Titer criteria were defined as follows: positive, titer ≥100 IU/L; weakly positive, titer 10–99 IU/L; and negative, titer <10 IU/L. We also compared titers before and 1 month after a single booster vaccination. Results Of the 5655 patients included, 3016 were male and 5 (0.09%) tested positive for HBV surface antigen. A marked reduction in antibody titer was observed until 4 years of age. Thereafter, the titers showed fluctuating decreases. HBsAb titers reached their lowest levels by 14 years of age. After 7 years of age, 50% of patients tested negative for HBsAb. Simple linear analysis showed that the titer reached levels of <10 IU/L and zero at 12.9 and 13.4 years of age, respectively. 1 month after a single booster vaccination was administered to those who were HBsAb-negative (n = 72), 69 children (96%) had developed antibodies while 3 (4%) remained HBsAb-negative. Conclusions In conclusion, the continuous reduction in HBsAb titers over time and in each age group was confirmed. The titer level was shown significant decline until age 4. More than half of the sample had negative titers after age 7 years. After booster vaccination, most of child significantly increase titer level.
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Affiliation(s)
- Kyeong Hun Lee
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Kyu Seok Shim
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - In Seok Lim
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.,College of Medicine, Chung-Ang University, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.,College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea.,College of Medicine, Chung-Ang University, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Young Bae Choi
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - Dae Yong Yi
- Department of Pediatrics, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea. .,College of Medicine, Chung-Ang University, Seoul, Korea.
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Low Prevalence of Occult Hepatitis B Infection Among Blood Donors in Beirut, Lebanon: Reconsider the Deferral Strategy of Anti-HBc Positive Blood Donors. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.14250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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World Hepatitis Day in Burkina Faso, 2016: Awareness, Screening, Identification of HBV Markers, HBV/HCV Coinfection, and Vaccination. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.13789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Esposito A, Sabia C, Iannone C, Nicoletti GF, Sommese L, Napoli C. Occult Hepatitis Infection in Transfusion Medicine: Screening Policy and Assessment of Current Use of Anti-HBc Testing. Transfus Med Hemother 2017; 44:263-272. [PMID: 28924431 DOI: 10.1159/000460301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/05/2017] [Indexed: 12/20/2022] Open
Abstract
HBV still represents a global risk factor in transfusion medicine. The residual risk of HBV is not limited to pre-seroconversion window period but it extends to donors with occult HBV infection (OBI) characterized by the presence of HBV DNA in liver and by the absence of the virus surface antigen. Each country developed an appropriate blood screening policy according to local HBV prevalence, yields of infectious units per different screening methods and cost-effectiveness. We underline the need of maintaining a high level of attention for OBI carrier identification in all blood banks worldwide where the screening procedures are generally based on a combination of both serological markers and nucleic acid amplification test. In this context, markers such as hepatitis B surface antibodies and hepatitis B core antibodies (anti-HBc) might be useful, although the use of this latter is highly debated and still controversial. Our aim is to give an overview on the relevant diagnostic approaches for the routine screening for HBV focusing on the feasibility of anti-HBc testing as precautionary measure in preventing OBI transmission worldwide. In our tailored algorithm, the loss of about 1% of 'anti-HBc only' donors, does not significantly affect the blood supply while improving recipient safety.
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Affiliation(s)
- Antonella Esposito
- Department of Internal and Specialty Medicine, U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Azienda Ospedaliera Universitaria, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Chiara Sabia
- Department of Internal and Specialty Medicine, U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Azienda Ospedaliera Universitaria, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Carmela Iannone
- Department of Internal and Specialty Medicine, U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Azienda Ospedaliera Universitaria, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Giovanni F Nicoletti
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Linda Sommese
- Department of Internal and Specialty Medicine, U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Azienda Ospedaliera Universitaria, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Claudio Napoli
- Department of Internal and Specialty Medicine, U.O.C. Immunohematology, Transfusion Medicine and Transplant Immunology, Azienda Ospedaliera Universitaria, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy.,Foundation SDN, Institute of Diagnostic and Nuclear Development, IRCCS, Naples, Italy
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40
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Safic Stanic H, Babic I, Maslovic M, Dogic V, Bingulac-Popovic J, Miletic M, Jurakovic-Loncar N, Vuk T, Strauss-Patko M, Jukic I. Three-Year Experience in NAT Screening of Blood Donors for Transfusion Transmitted Viruses in Croatia. Transfus Med Hemother 2017; 44:415-420. [PMID: 29344018 DOI: 10.1159/000457965] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/22/2017] [Indexed: 12/12/2022] Open
Abstract
Background Croatia implemented individual donation (ID)-NAT testing of blood donors in 2013 for three viruses HBV, HCV, and HIV-1 as a mandatory test for all blood donors. This study assessed the impact of NAT screening 3 years after its implementation. Methods A total of 545,463 donations were collected and screened for HBV, HCV, and HIV-1 using the Procleix Ultrio Plus Assay. All initially reactive (IR) NAT samples were retested in triplicate and, if repeatedly reactive (RR), NAT discriminatory assay (dNAT) was performed. ID-NAT positive donations were confirmed by RT-PCR on the COBAS AmpliPrep/TaqMan platform. Results Out of 545,463 samples tested, 108 (0.02%) were RR in NAT. There were 82 (75,9%) HBV reactive, 16 (14.8%) HCV reactive, and 10 (9.3%) HIV-1 reactive samples. 51 (47.2%) samples were ID-NAT positive only. Out of these 51 NAT yield cases, 1 window period HIV-1 and 50 occult HBV infections (OBI) were determined. There were only two potential HBV DNA transmissions from OBI donors. Conclusion The implementation of NAT screening for three viruses has improved blood safety in Croatia. During the 3-year period, 1 window period HIV-1 and a number of occult HBV donations were identified.
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Affiliation(s)
| | - Ivana Babic
- Croatian Institute of Transfusion Medicine (CITM), Zagreb, Croatia
| | | | - Vesna Dogic
- Croatian Institute of Transfusion Medicine (CITM), Zagreb, Croatia
| | | | - Manuela Miletic
- Croatian Institute of Transfusion Medicine (CITM), Zagreb, Croatia
| | | | - Tomislav Vuk
- Croatian Institute of Transfusion Medicine (CITM), Zagreb, Croatia
| | | | - Irena Jukic
- Croatian Institute of Transfusion Medicine (CITM), Zagreb, Croatia.,Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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A collaborative study to establish the 3rd WHO International Standard for hepatitis B virus for nucleic acid amplification techniques. Biologicals 2017; 46:57-63. [PMID: 28082100 DOI: 10.1016/j.biologicals.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/21/2022] Open
Abstract
Nucleic acid amplification techniques (NAT) are routinely used for clinical diagnostics and monitoring hepatitis B virus (HBV) infections, and are implemented on a voluntary basis for blood screening. A collaborative study was performed to evaluate a replacement WHO International Standard for HBV for the standardization of NAT. Two lyophilised HBV candidates were evaluated by 16 laboratories worldwide, alongside the existing HBV International Standard. The overall mean potency estimates for the candidate samples 1 and 2, relative to sample 3 (2nd HBV International Standard), from quantitative assays, were 5.93 and 5.98 log10 International Units (IU)/mL respectively. The variability in individual laboratory mean estimates for samples 1-3 for quantitative assays was ∼0.3 log10 IU/mL. The inter-laboratory variability for qualitative assays was higher. Accelerated thermal degradation studies indicate that both lyophilised candidates are stable and suitable for long-term use. Overall, the results suggested that both candidates were suitable as replacement International Standards. Sample 1 (NIBSC code 10/264) was established as the 3rd WHO International Standard for HBV for NAT with an assigned potency of 850,000 IU/mL (∼5.93 log10 IU/mL), when reconstituted in 0.5 mL of nuclease-free water. It is intended for the calibration (in IU) of secondary reference materials used in HBV NAT.
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Sosa-Jurado F, Hilda Rosas-Murrieta N, Guzman-Flores B, Perez Zempoaltecalt C, Patricia Sanchez Torres A, Ramirez Rosete L, Bernal-Soto M, Marquez-Dominguez L, Melendez-Mena D, Angel Mendoza Torres M, Teresa Lopez Delgado M, Reyes-Leyva J, Vallejo-Ruiz V, Santos-Lopez G. Prevalence of Serologic Hepatitis B Markers in Blood Donors From Puebla, Mexico: The Association of Relatively High Levels of Anti-Core Antibodies With the Detection of Surface Antigen and Genomic DNA. HEPATITIS MONTHLY 2016; 16:e36942. [PMID: 27630726 PMCID: PMC5011399 DOI: 10.5812/hepatmon.36942] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/02/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The hepatitis B virus (HBV) causes chronic hepatitis, hepatic cirrhosis, and hepatocellular carcinoma. Surface antigen (HBsAg) detection is a definitive test that can confirm HBV infection, while the presence of antibodies against the core protein (anti-HBc) suggests either a previous or ongoing infection or occult hepatitis B infection (OBI). OBJECTIVES The aim of the present study was to determine the prevalence of anti-HBc and HBsAg in blood donors. Further, the study aimed to estimate the anti-HBc level at which HBV DNA is detected in putative OBI cases, as well as to search for mutations in the "a" determinant associated with the non-detection of HBsAg in serum. PATIENTS AND METHODS We conducted a cross-sectional study from 2003-2009. The study included 120,552 blood donors from the state of Puebla, Mexico. Different commercial systems based on microparticles (enzymatic (MEIA) or chemiluminescent (CMIA)) were used to determine the HBsAg and anti-HBc levels. For the detection of HBV DNA, a nested polymerase chain reaction (nested PCR) was used and the genotypes were determined using Sanger sequencing. RESULTS Of the 120,552 blood donors, 1437 (1.19%, 95% CI: 1.12 - 1.26) were reactive to anti-HBc, while 82 (0.066%, 95% CI: 0.053 - 0.079) were reactive to HBsAg. Some 156 plasma samples collected in 2009 from anti-HBc-positive/HBsAg-negative blood donors were submitted for HBV DNA detection in a search for probable OBI. Viral DNA was detected in 27/156 (17.3%, 95% CI: 11.5 - 23.1). Our results show an association between HBV DNA or HBsAg and anti-HBc S/CO levels ≥ 4.0. All DNA samples were identified as genotype H and some "a" determinant mutations were identified, although none corresponded to mutations previously reported to hinder the detection of HBsAg by commercial immunoassays. CONCLUSIONS We observed that as the anti-HBc levels increase, there is a higher prevalence of the viral protein HBsAg in blood donors. Samples testing positive for HBV-DNA were seen to exhibit a ten-fold higher presence of anti-HBc S/CO ≥ 4 than those with S/CO ≥ 1 and < 4.0, which highlights the relevance of anti-HBc determination in blood donor samples.
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Affiliation(s)
- Francisca Sosa-Jurado
- Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico
- Corresponding Authors: Francisca Sosa-Jurado, Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico. Tel/Fax: +52-2444440122, E-mail: ; Gerardo Santos-Lopez, Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico. Tel/Fax: +52-2444440122, E-mail:
| | - Nora Hilda Rosas-Murrieta
- Laboratory of Biochemistry and Molecular Biology, Chemistry Center, Institute of Science, Autonomous University of Puebla, Puebla, Mexico
| | - Belinda Guzman-Flores
- Blood Bank Hospital, National Medical Center Manuel Avila Camacho, Mexican Social Security Institute, Puebla, Mexico
| | - Cintia Perez Zempoaltecalt
- Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico
| | - Ana Patricia Sanchez Torres
- Blood Bank Hospital, National Medical Center Manuel Avila Camacho, Mexican Social Security Institute, Puebla, Mexico
| | - Leticia Ramirez Rosete
- Blood Bank Hospital, National Medical Center Manuel Avila Camacho, Mexican Social Security Institute, Puebla, Mexico
| | - Maribel Bernal-Soto
- Blood Bank Hospital, National Medical Center Manuel Avila Camacho, Mexican Social Security Institute, Puebla, Mexico
| | - Luis Marquez-Dominguez
- Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico
| | - Daniel Melendez-Mena
- Department of Gastroenterology, Specialized Hospital, Medical Unit of High Specialty, National Medical Center Manuel Avila Camacho, Mexican Social Security Institute, Puebla, Mexico
| | - Miguel Angel Mendoza Torres
- Department of Gastroenterology, Specialized Hospital, Medical Unit of High Specialty, National Medical Center Manuel Avila Camacho, Mexican Social Security Institute, Puebla, Mexico
| | | | - Julio Reyes-Leyva
- Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico
| | - Veronica Vallejo-Ruiz
- Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico
| | - Gerardo Santos-Lopez
- Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico
- Corresponding Authors: Francisca Sosa-Jurado, Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico. Tel/Fax: +52-2444440122, E-mail: ; Gerardo Santos-Lopez, Laboratory of Virology and Molecular Biology, Eastern Biomedical Research Center, Mexican Social Security Institute, Puebla, Mexico. Tel/Fax: +52-2444440122, E-mail:
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Olotu AA, Oyelese AO, Salawu L, Audu RA, Okwuraiwe AP, Aboderin AO. Occult Hepatitis B virus infection in previously screened, blood donors in Ile-Ife, Nigeria: implications for blood transfusion and stem cell transplantation. Virol J 2016; 13:76. [PMID: 27150469 PMCID: PMC4859058 DOI: 10.1186/s12985-016-0533-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/25/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) transmission through blood transfusion is reduced by screening for hepatitis B surface antigen (HBsAg). However this method cannot detect the presence of occult hepatitis B virus infection. This study sought to determine the prevalence of occult hepatitis B virus infection among blood donors in Ile-Ife, Nigeria. For the first time in Nigeria we employed an automated real-time PCR- method to investigate the prevalence of occult HBV in blood donors. METHODS Blood donors screened with HBsAg immunochromatographic rapid test kits at the blood transfusion units of two hospitals and found to be negative were recruited into the study. Questionnaires to elicit risk factors for HBV infection were administered and then 10 ml of blood was collected from each donor. Plasma samples obtained from these HBsAg negative blood donors were screened again for HBsAg using an enzyme-linked immunosorbent assay (ELISA) method, and those found negative were screened for the presence of total antibody to the HBV core antigen (anti-HBc) using ELISA method. Those positive to anti-HBc were then tested for HBV DNA, using an automated real-time PCR method. RESULTS Five hundred and seven blood donors found HBsAg negative by immunochromatographic rapid test kits at both blood transfusion units, were tested for HBsAg using ELISA and 5 (1 %) were HBsAg positive. The 502 found negative were tested for anti-HBc and 354 (70.5 %) were found positive implying previous exposure to HBV and 19 (5.4 %) of the 354 anti-HBc positive had HBV DNA signifying occult HBV infection. No risk factors were found to be associated with the presence of HBV DNA among those who tested positive. CONCLUSION Occult HBV infection exists in blood donors in Ile-Ife, Nigeria and the use of HBsAg alone for screening prospective donors will not eliminate the risk of HBV transmission in blood transfusion or stem cell transplantation.
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Affiliation(s)
- Amadin A Olotu
- Department of Medical Microbiology and Parasitology, Bowen University/Bowen University Teaching Hospital, P.O. Box 15, Ogbomoso, Oyo State, Nigeria.
| | - Adesola O Oyelese
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Lateef Salawu
- Department of Haematology and Blood Transfusion, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Aaron O Aboderin
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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